Posted
by
Soulskill
on Sunday March 11, 2012 @05:12PM
from the as-soon-as-the-organleggers-spot-you dept.

Hugh Pickens writes "Dick Teresi writes in the WSJ that becoming an organ donor seems like a noble act, but what doctors won't tell you is that checking yourself off as an organ donor when you renew your driver's license means you are giving up your right to informed consent, and that you may suffer for it, especially if you happen to become a victim of head trauma. Even though they comprise only 1% of deaths, victims of head trauma are the most likely organ donors. Patients who can be ruled brain dead usually have good organs, while organs from people who die from heart failure, circulation, or breathing deteriorate quickly. But here's the weird part. In at least two studies before the 1981 Uniform Determination of Death Act, some 'brain-dead' patients were found to be emitting brain waves, and at least one doctor has reported a case in which a patient with severe head trauma began breathing spontaneously after being declared brain dead. Organ transplantation — from procurement of organs to transplant to the first year of postoperative care — is a $20 billion per year business, with average recipients charged $750,000 for a transplant. At an average of 3.3 donated organs per donor, that is more than $2 million per body. 'In order to be dead enough to bury but alive enough to be a donor, you must be irreversibly brain dead. If it's reversible, you're no longer dead; you're a patient,' writes David Crippen, M.D. 'And once you start messing around with this definition, you're on a slippery slope, and the question then becomes: How dead do you want patients to be before you start taking their organs?'"

... and I'm surprised that anyone is surprised by any of this. Frankly... If I'm braindead, or even slightly above braindead so that I can breathe myself, just kill me, mm'kay? There is no way in hell that I'll ever be "me" again. The "me" is dead, and that zombie-corpse-thing is not "me" anymore. Help others, save the financial cost and emotional burden to my family (even though I live in Europe, I expect the financial cost to be low... )... Take them, help someone. I am dead if my neocortex is not functioning correctly anymore.

There's a section in the article that states the Beating Heart Cadaver (BHC) still feels and responds to pain, yet no anesthetic is administered because the BHC is not considered to be a person anymore. I am canceling my organ donor card.

I don't trust how the system is set up right now. Last time I went to renew my license I didn't check the organ donor box, the DMV checked it for me anyway. I keep having to go online and cancel my registration, which is rather annoying. My issue is that these registries are run by private corporations with a financial incentive to be able to harvest people's organs and there aren't enough regulations in place. I would be willing to donate if it didn't involve money and I knew my rights would be protected.

Here are a few state donor registries where you can edit your donor information and make exclusionsFlorida [donatelifeflorida.org] Georgia [donatelifegeorgia.org] South Carolina [donatelifesc.org] Utah [yesutah.org]

I sure hope you don't find your organs being harvested because the doctor prefers to say "probably won't live" rather than "possibly will survive".

As they anesthetize the donor, I guess you won't wake up before they pull your organs. It leaves absolutely no chance that you'll open your eyes and say "Why is my chest open? Close it!"

My standing order regarding my life is this. If there's a chance I will live, give me the chance. If there's absolutely no chance that I will survive, let me go. If I am looking at a long, painful, terminal condition, give me the means to end it myself, and you can take what you want.

At some point, we all die. That's a given. If you die wishing someone else would die so you can get their organs, you don't deserve to live. You're wishing the early termination of another, when they may have had a chance, so you may have a chance. Why not go take organs from homeless, and give them to those who can afford such things? Pretend I didn't say that, it'll be the new Republican health care and economy saving plan.

Actually, it can increase your chance of survival. The doctors may try harder to stabilize you if they know you're a potential donar, because they know that even if you don't survive your organs are worth something. There's a slim chance that the extra effort to stabilize you will save your life, if the doctors were wrong to write you off too early. Assuming ER doctors (or paramedics) are more likely to make a bad call than a doctor deciding to switch you off in the ICU (where they have time to think), the organ card might be a net gain for you.

That would be the spinal cord, which can be alive when the brain is dead. And to prevent it from going haywire, we actually do administer anesthesia to dead people. I certainly spent enough late nights on call during residency doing organ harvests to know that.

That's exactly the kind of reaction I was afraid of when I saw the article. Thousands of people who are waiting for a transplant to save their life, will die because of people reading articles like this and going "maybe there's a tiny little chance that the doctors are wrong, who knows, maybe I'll still feel pain even without a brain, and maybe they'll find a miracle cure to revive dead brains during the hours that I'm brain dead, and who knows what else...".

Someone who needs a transplant to survive, has a 100% chance of dying if he or she does not get that organ. Weigh that against your "maybe this" or "maybe that". Once the doctors declare you brain dead, even if through some magical unexplained event you do come alive again, you're likely to be more like a zombie than your old self. And if your brain is dead, even though your body "responds" to pain, "you" won't feel a thing. Your brain is dead, you are not conscious, who cares if some of your muscles still twitch in an automatic reaction to pain.

Maybe people with a donor card should get priority to receive organs before any of the irrational and/or selfish cowards do. That would probably help a lot in the shortage of organs.

This sentence mostly shows just how little you know about transplantation. The problem is not the amount of organs, but whether a donor can be found with a compatible immune system. For any given recipient, it is extremely rare that there is more than 1 good donor, likewise most available organs are never used for anything. This would be true even if everybody donated organs.

It is frightening how strong an opinion people can have when being ill-informed to such a degree.

So no, nobody on the list will be grateful in the least. If there is an organ that would match me, chances that it will match someone else needing an organ are tiny. So nobody will be grateful.

If you were terminally ill and could only be saved with an organ from the victim of a traffic accident, would you refuse? If not, then stop being a hypocrite.

Oh great, hyperbole. If you were terminally ill and could get better if you just had the doctors kill some unknown homeless person, would you ? Some mentally retarded kid ? Some usually comatose old guy ? A black woman perhaps ? An infidel ? A republican ? A communist ? There's plenty of people who argue those lives to be less than worthwhile. "If not, then stop discussing."

And for the record, if I was not sure about the circumstances in which said organ was taken, yes, I would refuse. For one thing, why would my life be worth more to the doctor than that of the guy they cut open for the organ in question ?

IAAD and sometimes diagnose brain death - a lot of this academic debate ends up just scaring people or firing up various religious groups who have a problem with donation (but often have less of a problem with receiving donated organs).

It is good to have this debate, but like abortion, this is an area where people who deal with the messy situations that life provides should get to drive the policy, rather than any particularly flavour of god-botherers.

The basic idea is that God made a body with its particular destiny, and it's not man's job to screw with that plan. Some followers believe this means God gave them knowledge, intelligence, and the ability to cure disease, and no matter what happens, it's because God allows it. Other followers believe this means God made a plan for every part of the body, and if someone acts against that natural plan, they're violating the plan.

I agree with GP: This is an issue between patients and their doctors. Personally, part of my overly-elaborate assisted-suicide (though I don't yet know who or what will assist or in what manner or at what time) plan is that if I'm ever in a situation where 4 out of 5 doctors randomly chosen say I'm beyond reasonable hope for recovery, start cutting out recoverable parts. I have no interest in using them again.

The Church of Christ Scientist does not have a specific position regarding organ donation.

Or, in other words, some followers believe different things from other followers, as noted previously. There are groups (whom I've dealt with personally) that oppose organ transplant. No, the entire religion doesn't oppose it, but groups within it do.

Though I can only speak for personal experience from a past career, I've dealt with religious opposition to medicine from people who call themselves:

Jewish

Roman Catholic

Methodist

Atheist (yes, really)

Christian Scientist

Hindu

Quaker

That list is from medical records where people opted out of organ donation, and cited religion as the reason. Elsewhere, they specified a religion. Now, I only worked with the data, and not the patients themselves, so I can't elaborate more (though if anyone has insight on the atheist, I'd love to hear it).

Fair enough. Personally, I don't consider a position in direct opposition to a person's religion's official stance to a be representative of any "religious group", much as I would say that a person self-identifying as following Islam who says Allah doesn't exist, is not, in fact, following a position of a "religious group" (other than, perhaps, a group consisting of him/herself), but rather, is an individual with a wrong opinion about what their religion is--but in any case, the official stances are now li

IAAD and sometimes diagnose brain death - a lot of this academic debate ends up just scaring people or firing up various religious groups who have a problem with donation (but often have less of a problem with receiving donated organs).

I do not believe in a god, but I don't believe in organ donation either. I don't generally see a high quality of life for the recipients. In most cases it's just prolonging the agony. If the patients had more legs and the doctor had DVM after his name, this would have been called "inhumane".

It's time we drop the religious moral bullshit and treat our patients with as much respect as we treat our pets. Which includes letting them go when this is best.

I do not believe in a god, but I don't believe in organ donation either. I don't generally see a high quality of life for the recipients. In most cases it's just prolonging the agony. If the patients had more legs and the doctor had DVM after his name, this would have been called "inhumane".

Wrong. Recipients of kidney transplants have a high quality of life. As an anecdotal example, my son received a renal transplant 20 years ago and is sill going strong. For something non-anecdotal, see this [nih.gov] also.

What crap. A friend of one of my daughter's friends is a transplant recipient. I met her at a Halloween party a couple of years ago. She's about 13 now, I think. Without a transplant, she'd have been dead as a toddler. She seems pretty normal and happy to me, having a good life.

And there has never been a heart transplant recipient who has lived more than 10 years.

Bollocks. The current record is 31 years, set when 1978 transplant recipient Tony Huesman died in 2009. Dwight Kroening finished his first Ironman triathlon 22 years after his transplant. Five-year survival runs around 70%, and ten-year survival for heart transplants is about 50% [nationalpost.com].

A heart transplant certainly isn't a panacea; it's not a magical cure, and it carries serious and ongoing risks--but it's also not the unmitigated disaster that you seem to think it is.

this is an area where people who deal with the messy situations that life provides should get to drive the policy

It says each body is worth $2million. You don't think the people who deal with 'messy situations' can be corrupted by $2million? You might personally be a beautiful and friendly doctor who never does anything wrong, but the average human is going to be thinking about that $2million (even if it just goes to the hospital, and they don't get it personally).

It is good to have this debate, but like abortion, this is an area where people who deal with the messy situations that life provides should get to drive the policy, rather than any particularly flavour of god-botherers.

Like organ donors, perhaps? I am one, and I'm not cancelling my card over any of this, but don't subscribe to doctor's arrogance that deciding how to manage our ends is yours to do. It's ours. We appreciate your services, but don't forget that's what they are.

I agree completely, but I was a little surprised by the tests we apparently use to determine brain death. I assumed there might be an EEG to check for brain activity, but apparently they give you a wet willy and poke you in the eye, then turn off your air for a little while.
I'm cool with all my parts going into other people once brain death occurs, but I guess I'd just like them to check a little more rigorously to be sure it has occurred.
The article offers something of a solution: don't sign the card, but provide your family with instructions that your organs are to be donated after enough tests have been run to be sure your brain is kaput.

Exactly. People always say "Well what if they don't revive you and you could have been saved!" Honestly who cares? At the point of no return (my organs are being removed) I'm dead anyway! I'm not going to be sitting around for years looking back and thinking "Oh man I wish those doctors tried harder to save me" I'll be dead. Then anything they want to do with my body after that (organ donation, filming another Weekend at Bernie's) is completely up to them. I'd prefer to be useful to someone after death and telling me that there's a chance I might not be fully 100% dead before they officially pronounce me dead just because i'm an organ donor isn't going to change that.

I think the point made by the article is that we need more rigor in determining that the person is dead before the organs are removed. Obviously, they'll be dead afterwards.

There is no check for brain activity. They poke you a few times and remove your breather to see if you can breathe on your own. Note that a coma patient would fail some of those as well, and people *do* awake from comas. There is a big rush to declare you dead so that the organs can be harvested.

If I'm braindead, or even slightly above braindead so that I can breathe myself, just kill me, mm'kay?

Of course. If signing myself up as a donator takes lessens my informed consent in the case of massive trauma to my brain, so be it. Please use what you can to help somebody else, because if all I've got left is a few stray brainwaves, I'm really not going to notice if you take my heart and lungs and I really don't want my wife and daughter to spend any time worrying over a human rutabaga.

That's my view too. My greatest attribute is my intelligence and it forms, if not the entirety, the greater part of my persona. I solve puzzles for work. I play strategy games in my spare time to keep my brain going. As it was said in Sherlock Holmes, "I am a brain. The rest is mere appendage."

If I'm to the point where wiping my own ass is an accomplishment, come on man, I'm not in there anymore. Grieve, let the meatsack go, and celebrate the physical end of Beardo.

As for the parts, once I'm in that state or worse, I am done with them. I've said this before, but I'll say it again. Give my lungs to a old man so his grandkids can take their breath away. Give my heart to a teenager so it can get broken by her first crush. Take my kidneys out to a pub and have a beer on me. Watch one more sunrise with my corneas. Donate what's not useable to science. Burn what's left, use it to fertilize an apple tree, and bake me an apple pie.

Seriously though; it would be nice to believe that a miracle-cure for massive brain injuries is just around the corner (or in fact, a miracle cure for pretty much anything serious), but realistically you have to weigh your odds, and I don't like them. If I'm that much of a vegetable, I wouldn't want to hang around hoping..

Even if the brain could be physically repaired, I doubt there will ever be medical technology capable of restoring a person. We're talking massive head trauma, which more than likely means the cognitive, emotional and memory centers of the brain are destroyed or nearly so. Imagining that at some point you could be stuck in a vat and have your brain regrown would likely mean that you would largely be a whole new person. Maybe in some far off future we'll be able to back up our brains and restore them in case of serious damage, but that's not going to happen any time soon.

The younger the brain, the more plasticity it has and the more capable of recovering from severe brain damage it is. You might not be the exact same as you are now, but my dad certainly has a decent quality of life today. "He" is definitely still very much there, though sometimes he gets frustrated because he can't do everything he used to do, particularly in way he used to do it. He hates that he's dependent on others... but he finds plenty of enjoyment in life, looks forward to the time he gets to spend with his grandkids, etc. After years of resistance and despite being a grade school dropout, he's finally decided he wants to start learning about computers and stuff.

Massive brain damage isn't the end of the world, though it can certainly be difficult. I understand that it's quite scary to think about and a lot of people would rather be dead than face those challenges. That said, the younger you are, depending on just how severe the brain damage is, you can still have a positive life afterward and you still can even be you. Not every case is an absolute case of permanent vegetative state or "losing the soul."

I'm very glad your father survived and has regained much of his abilities. Was your father ever actually declared brain dead though? There's brain injury and then there's brain injury. Keep people alive just in case somehow a massively and catastrophically damaged brain might somehow make it back out the other side seems more like basing decisions based on someone else's anecdotal claims (like yours, for instance).

He wasn't declared brain dead... though the only stimulus he responded to during the first couple days of being in a coma was literally twisting his nipples until they bled. Had THAT not showed a response, he probably would have been. Maybe a less rigorous doctor doesn't even take it that far (and he was lucky enough to have a world famous neurosurgeon). On day #3, the day they told me was pretty much the point of no return, I came in and asked him to show me two fingers... he finally gave me a gesture, though it was just with one hand. I've gotta say, I don't think I was ever so happy to be flipped off in my life. I ran to the nurse's station to inform them and I kinda got a nonchalant "yeah, we know." Nice of them to inform me.

At the end of the day, doctors can and do make mistakes... and the patient's family is going to weigh the doctor's opinion heavily. Some won't allow it to overcome their internal biases, some have no biases and will just blindly do what the doctor says whether it is really in their loved one's best interests or not. In the end, we circle back to the question posed here... just how do we know when you are really dead for certain?

Actually, the criteria for brain death are widely published and understood. And the doctor who declares brain death is not the one who gets the organs - it's a neurologist or neurosurgeon, not the transplant guy.

I never said the neurosurgeon was the one that wanted the organs, just that doctors can and do make mistakes.

That MRI and CT series is from a night back about a month ago. About 2pm, my dad started complaining of a general headache. I gave him a tylenol #3 and an hour later, he asked for another because it still hadn't gone away. By 7pm, we were at the hospital ER, where he was complaining about acute localized pain in addition to the general headache and I informed them of his previous medical history o

We're talking about some imaginary technology that allows regrowth of brains from splattered bone, rock and whatever intruded masses with blood supply cut off to large portions for lengthy enough periods to kill a good deal of the tissue off. If we ever develop that degree of technology, I suspect growing new hearts, livers, kidneys, lungs, corneas and the like will have happened a long time before, and no longer will we have much need of organ donors.

Of course then we'll have people like you demanding "Let the headless motorbike rider who left most of his brain on the pavement of I5 live so his body can be reused, you have no right to let a perfectly good body die!!!"

Now that shit is DEEP. Not sure I agree, I think that as you are the sole caretaker of your body (in this reality or any other diminished capacity), the decisions you make NOW are still your own in regards to its (your body's) disposition. I'd like to think that what means something to me NOW as a conscious being trumps what someone else might think my recessed mind may perceive if I'm in a vegetative state.
I'd rather pass my carbon off to the next being, if anyone is interested in my opinion.

> Even if the person is no longer you, They still have a right to live.

Except that person doesn't exist until the brain is repaired. Before you perform the magic brain-restoration procedure there is no person 'inhabiting' the body, so the right to live does not apply. The act of repairing the brain to a useful state would be the act of creating the new person, and why would you create one new person (who, depending on the severity of the former brain damage, may have no skills and/or memories) when you can harvest some organs and preserve the lives of several already existing people? Why create a new person and effectively donate all the organs to him/her?

Back when dialysis was first perfected, the machines were extremely expensive and only rich people could afford to be treated. And since that's effectively a death sentence to the very large numbers of people in end stage renal disease (ESRD), there was a huge fuss. In the end, Medicare was extended to cover the cost of treatment for anyone with ESRD. No age restrictions, nothing.

When kidney transplants became feasible they were also covered. So the notion that you have to be rich or have excellent insurance to get a transplant is just plain wrong.

This is not to say that the system isn't borked, but that happens long after the transplant. Specifically, once you have a undergone a successful transplant you no longer have ESRD, so Medicare coverage stops. But your need for anti-rejection medication does not, and it's expensive. That's a separate thing, and the guidelines for it were set back when transplants rarely lasted for more than a few years. So the rules say that Medicare pays for the medication for 36 months, then coverage ends.

As a result a not-insignificant number of people with transplanted kidneys are forced to stop taking the necessary medication because they cannot afford it. Their transplants fail, and once that happens they're back in ESRD and on dialysis. And their Medicare coverage resumes. Oh, and did I mention that the medications are expensive, they're still significantly cheaper than dialysis? So this is truly a case of penny-wise, pound-foolish.

One final note. The coverage issue was addressed by the health care reform bill, but that particular provision doesn't kick in until 2014.

You cannot put back a soul into place once the brain matrix has rotten. The lungs or the heart may be restart, but it is no different than a computer with a fried CPU in which the cooling fans are still spinning. And no, you cannot repair the "CPU", because it would involve rebuilding trillions of neural connections that are unique to each human being and define, directly, who they are. Even in a far, far future in which you could repair these connections you would not know what to do since no one would bother (or afford) to take a backup of their own soul in case of trauma, and in such a sci-fi world rebuilding the body from scratch would probably be easier.

Brain death is irreversible, you don't come back from that. If something comes back, it will be a vegetable, not the original person.

Brain death is irreversible, you don't come back from that. If something comes back, it will be a vegetable, not the original person.

If you RTFAd, you'd find out that one person who was certified brain dead and whose organs were about to be harvested DID come back and was not vegetative. You can argue that they weren't really brain dead, but that just moves the argument up a level to how you determine brain death.

The whole article argues that we don't really know when someone is "dead" yet in the cases outlined; just best guesses by doctors.

Would you trust a doctor from 100 years ago today? Maybe we should hedge a bit that we may be killing people for their organs who aren't quite dead yet, and some more research needs to go into when you're officially "braindead".

From the summary, it says each person is worth 2 million dollars in a 20 billion per year industry. I would say that can cause some bias. Maybe, even a little unethical behavior. I remember reading recently about an operation in China where people were being harvested.

If we say an average doctor's salary is 200k per year that means each person they certify creates 10 years worth of salary to be distributed around the hospital staff and surrounding industries. Even

> If we say an average doctor's salary is 200k per year that means each person they certify creates 10 years worth of salary to be distributed around the hospital staff and surrounding industries. Even if the doctor himself is not being pressured to certify brain death, others in the hospital certainly are under pressure.

In my country (the Netherlands) people don't get paid for donating blood, so the incentive to donate too often and lie about disease and other risk factors is significantly reduced. Perh

Well, donors don't get paid in the US, either (and the article didn't say that). The article said that a body generates about $2 million in income for various parties (hospital, surgeons, etc.).

Think of it like this: If you're the owner of a toy store, and you got free toys because the next-door shop shut down (died), you'll still be asking full price when you sell them, and your customers will pay it.

That's some faulty logic. With so much money at stake, warlords aren't killing people to harvest organs. Poor people voluntarily do it for a small cut of the profits. The black market already exists, and the laws are keeping those black market activities alive.

The donors were recruited mostly from the slums of Brazil, flown to South Africa where the operation was performed, compensated between $6,000 to $10,000 and returned home [source: Rohter]. The South African middlemen were then able to sell the organs for as much as $100,000 [source: Handwerk].

There's absolutely NO POINT in banning compensation to the donor, because as soon as the organs are harvested, the people who have them can sell them. What do you think would change if organ donors received $500k in the US, except that the shortage of organs would fall?

You're insane. 100 years ago, leeching was still practiced, antiseptic surgery was still a relatively new concept, useful antibiotics didn't exist, blood transfusions were just barely being made practical on a significant scale, and organ transplants (other than skin) were still 40 years away.

If you're so far gone that modern doctors might be tempted to call you done for even though there's a very slim chance that modern medicine could bring you back, then you're so far gone that the doctors of 100 years ago would already have given their condolences to your family and headed home. And they wouldn't have given up prematurely because at that point, without modern life support equipment you're absolutely, positively gone.

I'll take modern medicine, thanks. It's imperfect, and the financial incentives for the physicians don't align all that well with the interest of the patients, but in large part it works, and you can't say the same for what passed for medicine in 1912 -- though it was orders of magnitude better than what we had in 1812.

There may always be the occasional error in anything. Is it acceptable to let ten thousand people die from lack of organ transplants in order to avoid each one case where someone not quite brain dead is accidentally killed? How about a million? Where do we draw that line?

28,000 people a year get organ donations. 20,000 less than the number of deaths every year in the US from traffic accidents. We still let people drive even with 50K deaths a year. I am NOT advocating shutting down organ donations; I'm advocating spending more money on research whether we're harvesting organs from individuals who are still viable living beings. What's the problem with that? What makes someone who needs an organ donation more important than someone who cou

That's the best explanation I've ever heard. "Dead" is simply the expectation that you're never going to be what we call "alive" again. Sometimes we're more certain than others. Run over by a steamroller? Yeah, we're pretty certain you're dead. Brain dead? We're pretty certain you're dead, just ever so slightly less so. Heart stopped? Ok, you're not dead, but you're definitely in danger of it if we don't get it started Very Soon Now.

If I'm braindead today, who cares what becomes available tomorrow? Maybe if a viable way to restart brain impulses after brain death occurs, I'll reconsider having signed my organ donor card. Anything could happen, I suppose, but I'm doubtful that technology will happen in my lifetime. As it is, I have signed it, and I have made a living will which states clearly that if I'm brain dead they're to line up organ transplant recipients and terminate life support. I'd rather give others a chance at life than continue to exist as a vegetable in the hopes that they might, maybe, some day come up with a way to undo that damage.

Brain tissue, once dead or severely damaged, can't realistically be restored the way it was, in much the same way that you can't restore a paper than has been burned. "You" is the structure of your brain. Even if damaged parts could be replaced with healthy new neurons, the old structure would be gone, which may change you in any number of ways (lost memories, lost skills, changed personality).

No, try reading the rest of the thread. I was talking about severe brain trauma in the context of the scenario of OP, who spoke about being brain-dead. The brain changes constantly, and my brain tomorrow won't be the same as my brain today, that hardly means I think I deserve to die tomorrow. I am not suggesting we kill everyone who loses the ability to juggle as the result of a major concussion. I just think that if we start replacing parts of the brain of a person with severe brain-trauma to a degree where the resulting person is pretty much indistinguishable from someone who has had a complete brain transplant (if such a thing were possible) we've abandoned 'curing the patient' and crossed into mad-scientist 'create new life' territory, and we're still using the body as an organ donor, but we're donating all the organs to the new person.

Besides, saying there are 'quite a few people who disagree with me' is irrelevant. If you have an opinion on any (semi-)controversial subject there will be billions who will disagree with you. I'm not interested in a popularity contest, if you disagree try giving an argument that is not based on pulling my words out of context and misinterpreting them.

Of course there would be situations where it's not clear how much the original person would change when using the miracle brain regeneration device, but I think the brain-death scenario is not one of those situations, so please don't go all Loki's Wager on me.

I burned out a good chunk of my brain in the 90's in a suicide attempt. I can still function, hold down a good job, have a relationship. I'm not the same person i was before the incident but I'm still a person with feelings, hope, dreams and rights.

Indeed, the earth has fire every day. You're wrong about the huge ball of fire though. And in neither case is there a mechanism by which either could result in the earth being consumed by fire tomorrow, or within our lifetimes.

Whereas by contrast, there is indeed brain restoration research being conducted, and the breakthroughs that will fix this or that brain issue will arrive mostly in our lifetimes.

"Locked In Syndrome" is not comparable to braindeath. Also, if you're braindead under the current diagnosis methodology, it's pretty much guaranteed you'll never wake up. Never ever.
You're trying to convince us here that two different states of coma are comparable to braindeath. This is not so. Not to mention, by the way, that you have better odds of winning the lottery than waking up from a coma after you've been in said coma for more than a year.

(Sounds silly, but it is kinda valid- can't restart heart, and/or can't restart breathing, and/or can't ever recover brain function/consciousness). Of course, in reality, it can be a bit more difficult to define. Personally, I think it is all about the brain. If the brain is irreversibly damaged to the point there will never be consciousness, I don't care how functional the rest of the body is, that person is DEAD.

Interesting article, but I'm going to categorize it under scare-mongering. I'll accept the next to nothing possibility of being still alive while they take my organs, if that means saving other's lives.

From the article: "Even some of the sharpest critics of the brain-death criteria argue that there is no possibility that donors will be in pain during the harvesting of their organs...But BHCs[beating-heart cadavers]-who don't receive anesthetics during an organ harvest operation-react to the scalpel like inadequately anesthetized live patients, exhibiting high blood pressure and sometimes soaring heart rates. Doctors say these are simply reflexes." OK, but didn't we once say something similar about operating on babies without anesthesia [naturalnews.com]?

At least one of the cases described in the linked article should be grounds for legal action, at the very least dismissal of these surgeons from their jobs. Case #2 seems a collection of mistakes and errors: was permission granted by or even asked from the family? Dismissing objections of one of the teammembers? Designated target dies before even receiving liver and the donor dies as well? I mean... this sounds like a case for a law school, not for medical school.

However... most donations are rigged with very careful procedures precisely because of all the legal pitfalls. Given the good it does to help with the mourning process of the family of the donor, and the good it does on the other side, there is a powerful drive to make sure we improve this procedure.

My wife is a physician and she is not an organ donor and when we got married she made me opt out of organ donation.

She did a rotation in one of the largest and most respected shock-trauma units in the country (University of Maryland) as part of her residency and says that as soon as they wheel somebody in with head injury trauma the team goes to work to save them but at the same time one member of the team starts typing the organs for possible transplant.

She says she won't sign the card because she doesn't want somebody trying to "save" her when there are hundreds of thousands of dollars involved if it goes the other way.

Your wife is a physician and doesn't realize that organ harvesting and transplanting is a very time sensitive procedure? Typing the organs right away, even before death is declared, saves a bunch of precious time that if wasted could lead to a non-viable organ in the end. Just preparing for possible contingencies is not nefarious, it's logical. In the end, if the patient recovers, then hooray for the patient! We move on to the next possible organ donor.

The system is not evil, doctors are not ghouls just waiting for the next big organ score. And personally, I feel that if you are morally opposed to organ donation, you should be morally opposed to organ reception; that is to say, feel free to opt out of the system, but your name should be on the bottom of the UNOS list if the time comes you ever need the help of said ghoulish transplant doctors.

Good for you for being an ER doc. I have a lot of respect for you guys. Having said that, I'm an EMT, and I've seen stuff that would curl your hair. You get them after we've pulled their various parts out of the car (not always at the same time) and cleaned them up for you.

I've gotta say, I know a bunch of docs at one of the best trauma centers in the country, and they are without exception good people fighting a forever-losing game against death. There's all sorts of people who "could" be saved - but for what? It's not a money thing at least to the folks I know - they just don't see fighting to keep the patient in a coma on a vent for a few more days as appropriate - to the patient, or their families.

Since I'm sure you'd shit all over any hypothetical I offered, here's a real case: Massive car accident on the highway, one guy didn't have his seatbelt on and went partway through the windshield. Massive head injuries (open skull and brain tissue on the windshield), and cardiac arrest. He was our only "red" patient, but we didn't do CPR.

Now first of all, the standing protocols in my state is "do not perform CPR if it was caused by a traumatic cardiac arrest", so we were doing right by that. Notwithstanding, we perhaps could have pumped him with some lactated Ringer's, tubed him, and performed compressions. We may have even brought back a pulse (his brainstem appeared intact). But for what?

Let's say you are that guy's wife, or brother, or son. Which is better? "He died in a horrible car accident" or "He's in a coma, it doesn't look good"? Sure, the doctor can say up and down that he won't make it, that the windshield ripped out parts of his cerebrum and people don't come back from that, etc - but it doesn't matter, most people get their hopes up because he isn't actually dead. Then a few days later the guy dies, or even worse, his next-of-kin has to make the decision to give up. If it were me, I know which one I'd rather have, for me and my family. Get it over with and leave it at that. Don't stretch it out to various stages.

And yes, those things will stay with me for the rest of my life. But we still made the right call.

I don't know what you mean by saved. Perhaps you mean the guy coding could've been stabilized, but they gave up, or perhaps you mean the terminal cancer patient wasn't vigorously resuscitated. If "save" means "most likely could've returned to a mostly-normal life", that's a tragedy worthy of big punishment. But if "save" means "kept alive for a few more hours/days", I can't say I share your disgust at the doctor having some mercy to everybody involved and just letting it end naturally.

I'm choosing to read it as the emerge room team spending a lot more money on a potential donor, than they would on someone who isn't. In the case of someone with a major head injury, tissue typing is pragmatic: there's a huge demand for organs, and the chances of a match succeeding are much higher when they're still fresh. You can bet that they're also networking with transport teams, and even just preparing for a potential trip from donor to recipient is expensive. All of that is wasted in the event of a successful resuscitation.

Meanwhile, if you don't have a card, costs are limited to the effort of bringing you back. In the event of the worst happening, they can keep you on life support and ask your next of kin about harvesting. Sucks for the people on waiting lists, but it's not like they aren't already cooling their heels.

I have a cousin who years ago was in a massive car accident and thrown through the windshield. Full coma and braindead. His family kept hope for a while and then had the plug pulled. Shockingly he kept breathing which seemed to give everyone hope. Here we are 15 years later and he is just as much brain dead as he was then but his direct family has been absoluetly through the ringer and his parents are absoutely broke. Looking back on what that has done to his family and what his quality of life is, I would absolutely say go ahead with the donation and make someone else's life better.

Okay, read that in whatever punny way you like but after seeing the prices organ donors' organs fetch, I want to be an organ donor but I want to be paid for it NOW.

The only one who doesn't benefit is the donor!! How wrong is that?! If I am going to be a donor and the medical industry is going to benefit from it, then they need to share that benefit with me. Sure. Put me on a health plan and require me to live within certain healthy standards. I don't drink that much anyway. I don't do drugs. I don't smoke. I don't run around having casual sex either... (not my choice really... I think I would if I could.) I'm a pretty healthy candidate all in all.

I know by my asking for this I'm setting myself up for one of the opening scenes from Monty Python, but I'm certainly not going to volunteer myself while other profit from it.

Not only does the summary have absolutely nothing to do with "news for nerds," but it reveals an agenda that is probably (if you scratch it deeply enough) based on religious asshattery rather than sound medical, scientific, or ethical principles.

Case in in point: But here's the weird part. In at least two studies before the 1981 Uniform Determination of Death Act, some 'brain-dead' patients were found to be emitting brain waves, and at least one doctor has reported a case in which a patient with severe head trauma began breathing spontaneously after being declared brain dead.

You know who else emits brain waves and breathes spontaneously? Pretty much every life form in kingdom Animalia.

Why did the submitter not choose to reveal his/her actual agenda, rather than duping an editor into publishing this stupidity? Organ donation saves lives... real lives, lives which are distinguished by characteristics beyond the ability to inhale oxygen and exhale CO2.

While you're right that the OP is probably a religious asshat trying to get his wacky agenda some air time, you can't deny the huge incentive hospitals have to declare someone "brain dead" who maybe is or maybe isn't or is maybe on the cusp, because they make $750K PER ORGAN harvested.

...

What nonsense. Organ transplants COST $750,000 to perform because they are difficult, elaborate, high-tech, risky procedures -- it can't be done for $5 grand by Dr. Nick. That money goes to a lot of expenses the hospital doing the transplant has pay for, large amounts of medical supplies, a lot of highly trained human labor, etc. And you realize, I hope, that this is not some profitable side-line a hospital adds on to fatten its bank balance. Transplants requires special certified, highly qualified teams that must pass rigorous certification. Many transplants are done in regional centers that specialize in doing them because it makes the transplants more successful (practice makes perfect) - these centers aren't medical casinos raking in dough.

If on the DMV form you have an exclude checkbox for organ donation, 98% of population will donate their organs by default. So much for human psychology... as a society we are at a stage where we need make some conscious choices if supply is low we need to understand all possible root cause and try to fix them.

a $20 billion per year business, with average recipients charged $750,000 for a transplant

Seriously, if this is such a big business, I want to be paid for my organs. Why should some medical institution or insurance company profit from my flesh? Obviously I won't be around to enjoy it, but I hope my son will. I would be very happy to know that my heart, liver, kidneys, eyes, etc. provided funding for his college education. I can't figure out any other way I'm going to be able to put him through school. Hell the state universities cost more than the private ones did in the late '80's.

Is drinking and driving laws. During the period where drinking and driving was the norm, and seatbelt/helmet use was almost unheard of, there was no lack of young, healthy donor organs.Social pressure has wreaked havoc on this, and created a new, younger class of unemployed.The answer is simple - re-enable driving around shit-faced and MDs will be swimming in spare kidneys and other bits; and we can resume full employment.

That's a lie in the article fabricated to shock. The cost of a transplant is $750,000, but they don't mention what that is, and then imply that's the cost of the organ. That's the cost of the doctors and drugs and tests and such to put an organ into someone, assuming the organ is free. Add $50,000 for the organ, and it'd move the cost to $800,000. Moving organs is expensive, and the article is written by an anti-transplant person trying to dissuade others from donating.

This is completely nonsense. No doctor goes around hoping to declare patients braindead so that we can take your organs.

Yes, clearly every doctor in the world is an uncorruptable paragon of virtue and empathy. It's ridiculous to think that anyone could ever possibly become a doctor because they are motivated by greed and willing to take ethical short cuts as a result.